Wednesday, April 21, 2010

Back When Psychiatry Was (Sort of) Enlightened

I'm in a downtown hotel right now, ready to fly out to Kansas tomorrow to give two talks as the keynoter at the Kansas State DBSA conference, to take place Saturday in Manhattan. Following is a segment from my second talk ...

My research often takes me to strange places. This little adventure started in front of my computer. One day, for the heck of it, I checked out the very first issue of the American Journal of Psychiatry, which came out in 1844. Back then it was called The American Journal of Insanity.

The American Journal of Psychiatry is published by the American Psychiatric Association, which was also founded in 1844.

Now, you heard me mention this morning how modern brain science is showing that stress makes us sitting ducks for all kinds of mental illness and other weird stuff. And I also mentioned that psychiatry already knew this back in 1952 when the first DSM came out. As it turns out, the principle was already an old one back in 1844.

Of all things, this first issue of the Journal of Insanity had a long article dealing with Shakespeare. Cool, I thought. So I started reading. This from King Lear:

Be comforted, good Madam, the great rage 
You see is cured in him, and yet it is danger 
To make him even o’er the time he has lost; 
Desire him to go in, trouble him no more 
Till further settling.

As the Journal observed:

Now we confess, almost with shame, that although near two centuries and a half have passed since Shakespeare thus wrote; we have very little to add to his method of treating the insane.

Wow. So this is an ancient principle, then. And the modern psychiatric science of 1844 just validated it.

The Journal goes on to say:

To produce sleep and to quiet the mind by medical and moral treatment, to avoid all unkindness, and when patients begin to convalesce, to guard, as he directs, against everything likely to disturb their minds, and to cause a relapse is now considered the best and nearly the only essential treatment.

Hold on a sec ... Wasn’t 1844 supposed to be the Dark Ages? Weren’t asylums terrible places where they locked away - “the insane”?

Well, it turns out the 1830s and 40s was a great reform era. Abraham Lincoln came of age around this time. This was a time of enlightened science meeting enlightened Christianity. Have you had a look at the buildings and grounds of these old institutions? They were beautiful. Palatial country estates.

They even had farms attached to them.

Well, talk about coincidence. It turns out that this same 1844 Journal - the one that had a long piece on Shakespeare - also had a report describing an institution in Utica, then in operation for 18 months. According to the report, of 433 patients admitted, 123 had recovered.

Okay - we can’t be sure what the report meant by the term, recovery. But it is fair to assume that in an age of no psychiatric meds or other treatments - or so-called “treatments” that made patients worse - more than one-quarter of those admitted were deemed to be in good enough condition to return to their homes and communities.

About a year after I came across that 1844 psychiatry journal, I found myself in LA. I was on my way to my daughter’s wedding in New Zealand and I was staying at a friend’s house before flying out.

I don’t know about you, but I don’t look forward to holidays. Because that means I have to crank out three weeks worth of work in just one week. So here I am, in LA, all worked out - stressed, if you like, needing to relax, needing to get away from work.

I should have known. Maybe a lot of you know this already. If you’re a mental health advocate, you really gotta watch hanging out with fellow mental health advocates. So what’s my friend’s idea of a good night on the town? Attending a three-hour lecture on mental health, that’s what.

Great. I’m in vacation mode. I want to forget about work, and here I am being dragged out into the night to sit in on a university class for some psychology majors at USC. A leading world authority on psychiatric rehabilitation, Robert Liberman of UCLA is giving a guest lecture.

Well, I decide to go with my friend, but that doesn’t mean I have to listen. Anyway, here I am, in a college classroom, trying very hard not to listen, when suddenly Dr Liberman starts telling us how the insane asylums of old were very enlightened places, with high recovery rates.

My ears pricked up. Wait? Hadn't I read something like this?

Dr Liberman went on to say in so many words that mental illness was a product of the industrial age. Jam people into cities and watch what happens.

Asylums were built to get people away from all that. Only later, he explained, did cash-strapped state governments give up on us.

Of all things, on the ride back, I’m thanking my friend profusely for dragging me out into the night.

Catch me in Kansas. For further details ...

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